After nearly three decades providing care to seniors and the disabled, Saint Agnes Adult Day Health Center will close Friday, the latest in a string of centers in California that have closed this year amid uncertainty about state funding.
That will leave fewer options in Fresno County for about 1,000 adults who are medically fragile – and almost all low-income. About 48 people at the Saint Agnes center must find other places for care.
Saint Agnes is one of 17 centers statewide that have closed this year, and more of the 300 centers statewide are expected to close. That could force some family members either to quit jobs and stay home as caregivers, or to put loved ones into nursing homes.
The centers are similar to child day care. The elderly and disabled stay there during the day so relatives can work or have a respite from caregiving. But unlike child day care, the adult centers include health care as a central feature.
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For people like Allan Gonzales, the possibility of losing services is frightening.
The 46-year-old Fresno man takes his wife, Patricia Gonzales, to Valley Adult Day Health Care Center in southeast Fresno three times a week. Patricia, 36, has been a quadriplegic since suffering nerve damage from an anesthesia accident during the birth of the couple's daughter 11 years ago. At the center, she gets physical therapy to help increase her mobility, among other services.
Since she enrolled at the center four years ago, her health has improved.
"She was barely pushing a cup on the top of the table," Allan Gonzales said. "Now she picks up the cup and puts it to her mouth when she's thirsty – not perfectly, but she does it."
The day care enables Gonzales to keep working. He cleans office buildings and works as a mechanic. If the adult day health-care centers close, he would have to quit his job and stay home with his wife, he said.
"Me and her, we'd probably be stuck on [welfare]," he said.
This isn't the first time adult day health-care centers have faced the threat of closure. Last year, advocates successfully went to federal court to block the state's attempts to reduce services and change eligibility requirements.
This June, Gov. Jerry Brown eliminated the program as a Medi-Cal benefit. He did it to save $169 million.
Two weeks ago, the governor confirmed the elimination by vetoing a bill that would have provided $85 million for a scaled-back adult day health-care program.
Medi-Cal is scheduled to stop paying the centers after Dec. 1.
Without Medi-Cal reimbursement, it's almost certain centers in Fresno would have to fold. Countywide, of the 1,016 people in centers, 951 rely on the state-federal insurance for low-income clients, according to the California Association for Adult Day Services.
Advocates for adult day health-care centers said the governor was misguided to eliminate the Medi-Cal benefit.
The state will end up paying more for seniors and the disabled in nursing homes and at hospital emergency rooms, they say.
The state reimburses adult day health-care centers $76 a day for the care of a participant. Nursing homes receive an average of $173 a day per resident.
Several organizations, including Disability Rights Calfornia, have gone to court to try to save the program this year. A federal court hearing is scheduled for Nov. 1 in San Francisco.
Meanwhile, Saint Agnes Medical Center saw the handwriting on the wall.
The weak economy, as well as a loss of Medi-Cal reimbursements, made it necessary to close the adult day health center.
"We did not have confidence the state would reinstate funding for adult day care," said Nancy Hollings-worth, interim chief executive officer.
The center opened in 1983. It employs two people full-time – a program director and supervisor for social services – who will lose their jobs. Another 13 part-time employees will be out of work after this week.
The hospital gave the employees, families and participants a 60-day notice of the closure. But how many participants found new places of care within that time wasn't known.
Where to turn
State health officials say they are not abandoning the 37,000 elderly and disabled in the centers. They say their transition plan will keep people out of institutions and living independently in communities.
"That's been the goal from Day One, that people have the ability and opportunity to remain free from institutions," said Norman Williams, deputy director of communications for the California Department of Health Care Services.
But the state's plan relies heavily on cash-strapped counties, as well as on managed-care insurance companies to provide services they can't be sure the state will pay for next year.
The state wants to increase hours for people who provide care to seniors and the disabled in homes. Many of the in-home supportive services caregivers are family members. The state pays them to prepare meals, clean homes and help seniors and disabled with such tasks as bathing and dressing.
But counties would have to assess the elderly and disabled to see if they qualify for caregiving hours – and Fresno County doesn't have enough staff to handle the extra load, or the money to hire more people.
"It would be a workload issue, and it might cause some delays in getting out there to see those new applicants," said Joel Gurss, the In Home Supportive Services manager for Fresno County.
Under another part of the state's transition plan, managed-care plans would provide services to help people stay in their homes.
Managed care executives are waiting for details from the state. But it's doubtful the state would have the money to reimburse health plans providing the services, said Greg Hund, chief executive officer for CalViva Health, a new Medi-Cal managed care health plan in Fresno, Kings and Madera counties.
"It's likely it will be an unfunded benefit," Hund said. "So the health plans will just have to absorb it."
Operators of the centers aren't convinced the state's plan will be in place by Dec. 1, and the job of finding alternative care for 1,000 medically needy people would fall on the centers' shoulders then. Centers would be responsible for discharge planning.
The state has yet to tell them where to find the resources, said Teng Vang, program director at Adult Day Health Care of Fresno and Clovis. "There's a lot of confusion," Vang said.
Williams, of the Department of Health Care Services, said the state is evaluating the needs of 8,000 participants who attend centers four to five days a week. The state intends to have a transition plan in place by Dec. 1.
In the meantime, families and participants wait and worry.
Allan Gonzales said he understands the state money crunch and the need to save money. "But this is not the place to save it," he said.